October 19, 2001
The New York Times, at the amfAR-sponsored continuing medical education symposium "Focus on Women: Challenges in the Prevention and Treatment of HIV/AIDS."
I'm sorry Marcia Gillespie couldn't be here, and I'm honored to stand in for her. She is a forceful, powerful, passionate speaker and a forceful, powerful, passionate person.
Thank you very much for your commitment to learning more about the very important topic of HIV and AIDS in women. This afternoon, I am going to talk specifically about women of color, particularly African-American women, which is what I know best. I wrote my first story about AIDS in 1985 when the disease was still called GRID. It was my first feature for Essence, and I wondered why I, a young writer, was given this important story. I later found out that no other writers wanted to interview people infected with this mysterious, deadly disease. The subject was so new, particularly the science of it, that my editor in chief paired me with her college biology instructor to assist me in writing the story.
I'm going to offer you a few startling stats. Although you've probably been inundated with them, here are a few more:
I highlight these statistics to show that, for various reasons, it seems that African Americans, particularly African-American women are not paying attention to the prevention message. And that's what I would like to focus on today. Why isn't prevention working for African-American women? (As a side note, prevention may not be working so well even with white gay men, since new infections are up in that group, a group that was considered a prevention success story.) Interestingly, it is probably NOT because they are lacking information. Estimates show that almost 95 percent of people can tell you what AIDS is, how it is caused and that if you get it you may die from it. So it's probably not that people don't know the facts. It is probably much more complicated than that.
I'm going to go through several factors that might help explain why in this day and age so many black women are contracting HIV. I'd like to say that I'm not going to speak specifically about socioeconomic factors, because that's something most of you already know. Briefly, black women are disproportionately poor, lack health insurance, lack access to affordable health care and are more likely to distrust and avoid medical services. That is, by and large, the reason that we are more likely to die of nearly every serious illness more often than white women, even ones that we contract less frequently, such as breast cancer. But the issues I am going to discuss, the reasons we make up so many new cases, really go across class lines.
First, it's important to look at the depth of the disease in the community. Obviously, there are fewer blacks than whites in the U.S.; however, our community has a disproportionate rate of HIV and AIDS cases. To put it another way, 1 in 50 black men have HIV and 1 in 160 black women have HIV. To compare, the rate is 1 in 3,000 white women. So if you are a black heterosexual woman, and you prefer black men as your sexual partner, your risk of contracting the virus if you are having unsafe sex is pretty high. In essence, it may not be that we are having any more risky sex than other races, but each time a black woman engages in unprotected sex with a man of her race, she's putting herself at great risk.
Another factor has to do with the homosexuality in our community. The stigma against being gay is perceived to be greater than in the white community, particularly for men. The key is the word "perceived." It is not that there is more homophobia in the African-American community, but that the fear of coming out may be higher. There is no Chelsea or Castro for black gays, particularly men, so they stay in the communities, communities that are havens against an often-hostile world. Because they don't want to be ostracized by the other blacks that they live with, gay black men may be afraid of coming out or being open about their sexuality. This means they end up on the so-called "down low." This term means men who sleep with men but also have sex with women -- and this phenomenon is generally accepted to be higher among blacks than whites. Of course, nothing's wrong with this, unless it's being done without protection. The famous Valleroy study last year showed that as many as 30 percent of young black gay men may be infected with HIV, and these men are more likely than white men to have sex with both men and women. I don't have to spell this out any more clearly: if there are men infected with HIV and having unprotected sex with women, it helps to explain the high new rates of HIV among black women.
Now, the two factors I mentioned explained the numbers, but they don't explain the behavior. If so many black women know how to prevent HIV -- and they really do know and can even tell you that having a man wear a condom during sex will prevent transmission -- why not just have protected sex or refuse sex if the guy won't put on the condom? Here are three reasons, fairly unscientific, but I think true:
In conclusion, increasingly, you'll be dealing with African-American women as your patients. I hope I've given you some things to think about and things to consider as you do the hard, important work of stopping the virus and caring for those who are living with it.
Linda Villarosa is a contributing writer to the Science section of The New York Times and the former health and fitness editor of the Times. Over the past year, she has written several articles in the "AIDS at 20" series that has run in the Times. Most recently, she profiled HIV-positive women who make the choice to become pregnant. Linda is also the former executive editor of Essence Magazine. She wrote her first article about AIDS for that publication in 1985. She is also the author of several books, including the bestselling Body & Soul: The Black Women's Guide to Physical Health and Emotional Well-Being.